The Oneida Daily Dispatch (Oneida, NY)
Oneida supervisors, county officials talk Medicaid issues
Oneida City Supervisor Brandee Dubois attended the New York State Association of Counties Legislative Conference in Albany on Feb. 27, 28 and March 1. She joined a number of county officials to discuss ongoing issues with state lawmakers include budget and climate concerns.
“I joined Chairman John Becker and Oneida Supervisor Mary Cavanagh attended the NYSAC Legislative Conference in Albany a few weeks ago,” Dubois said. “We also had several other supervisors and department heads at the conference. One of the big topics was EFMAP, the governor’s budget and the Climate Act was another big topic.”
Becker serves as the President of the Board Chairs. During the conference, he spoke in favor of the resolution to return the EFMAP funding.
Medicaid is a safety-net health plan aimed at the poor and disabled which is jointly financed by the federal, state, and local governments. It benefits one in five Americans, including over 17,000 Madison County residents.
In 2003, the Affordable Care Act enhanced Federal Medicaid Assistance Percentage, or EFMAP, created the state as a federal passthru to the counties and New York City.
Each year Madison County receives $1.6 million through the EFMAP program to help offset the $10 to $11 million a year that Madison County taxpayers pay for the Medicaid program. For 20 years the federal government has provided EFMAP funding to states and localities in New York state. The money goes through the state to the localities.
The 2023-24 Executive State Budget proposes to withhold $625 million INEFMAP funds; $281 million of those funds will come from counties and $345 million from New York City.
Instead of sharing these federal dollars with counties to apply toward local tax relief, the proposed state budget and financial plan divert the funding to other areas in the $227 billion state budget, including depositing $5.4 billion in reserves.
“Expanding eligibility and making sure reimbursement rates are raised for healthcare providers such as hospitals and ambulance services is a great thing,” Dubois said. “However, the state did not think about how to pay for that before they decided to make those decisions. It shouldn’t be done on the backs of the counties, making us pass along the cost to our residents who are already strapped due to increases in the cost of living and rising food prices.”
Madison County will lose $833,000 in 2023 that has already not been budgeted, so the county will have to make up the difference. And Madison County would lose an estimated $1.5 million every year after that.
“In order to make up for that lost money, Madison County, as every other county, must look at either raising taxes or cut services such as highway or law en
forcement as examples,” Dubois said.
Hochul’s budget proposal for fiscal 2023-24 calls for the state share of Medicaid to rise by 9% or $2.9 billion, following a 14% jump in fiscal 2023. From 2011 to 2022 the average growth rate was 4% The state share has actually been going down in the last three years due to additional federal funding.
The Assembly and Senate budget pitches include a rejection of the governor’s budget proposal that would withhold that federal funding from the counties and be kept by the state.
NSYAC on March 14 released a statement saying, “We applaud our partners in the State Senate and Assembly for rejecting Governor Kathy Hochul’s proposal to shift $625 million in new costs to counties for the state’s Medicaid program from their one-house budget plans.”
NYS total contribution for fiscal 2023, at $31.5 billion, outstripped school aid as the single largest item in the state budget. New York State counties contribute $7.6 billion a year to Medicaid, more than all other counties in the nation combined.
The contribution by each county has traditionally been capped. Madison County’s CAP is nearly $11.5 million. Madison County for the 2023 budget allocated $10,053,019 to be sent to NYS for Medicaid. In 2022 that budget amount was over $10.3 million.
Madison County is also requesting the state reconcile the COVID EFMAP savings it is owed for the past three years, which amount to over $2.4 million for 2019 — 2021. This was funding passed down from the federal government to the state for the counties. Including 2022, the total is nearly $4.6 million owed to Madison County.
“Governor Hochul, when asked about the counties’ concerns about EFMAP, said that the state has done other things to help counties including increasing collections of online sales tax,” Dubois said. “It should be noted that New York state also receives a percentage of that money.”
The Medicaid cap was enacted in 2011 and the cost for all 62 counties totals $7.6 billion. This cap has saved counties and local taxpayers billions of dollars since its enactment and made local taxes more affordable. Counties and local taxpayers greatly appreciate the relief provided by the state.
In 2020, Gov. Andrew Cuomo suggested eliminating the cap. However, that proposal was dropped. In three years, the impact of this new proposal by Hochul will compound, costing local taxpayers across NYS more than $2.5 billion over the three-year period.
County officials made other contributions during the conference.
County Administrator Mark Scimone is the Chair of the Standing Committee on Public Employee Relations, which put forward a resolution to study and reform NYS Civil Service System. And Madison County Director of IT Paul Lutwak, who chairs the IT Task Force, put forward a resolution to commend the state’s support of local cybersecurity efforts.
NYSAC officials rewarded Dubois for graduating from NYSAC’S County Government Institute. Dubois works as a registered nurse along with her duties at the county.
“I graduated from the county government institute during NYSAC as well. I had to earn continuing education credits by taking courses on my own time to achieve this,” she said.